Skeletal and Dental Variables Related to the Stability of Orthognathic Surgery in Skeletal Class III Malocclusion With a Surgery-First Approach

Purpose: The objectives of the study were to identify the parameters related to skeletal stability after orthognathic surgery in skeletal Class III malocclusion using a surgery-first approach and to analyze the factors correlated with surgical relapse. Materials and Methods: Forty-five consecutive patients were included. Serial cephalometric radiographs were traced and superimposed to investigate surgical stability at the initial examination, 1 week postoperatively, and after orthodontic debonding (12.22 mo after surgery). Patient grouping was based on the amount of horizontal relapse at the innermost point of the contour of the mandible between the incisor tooth and the bony chin, the B point (less stable group, n = 15; highly stable group, n = 18). Parameters, such as presurgical skeletal and dental variables, the amount of surgical setback, and total treatment duration, were compared between groups and analyzed for correlations with surgical stability. Results: The mean setback at the innermost point of the contour of the mandible between the incisor tooth and the bony chin was 11.19 mm, and the mean relapse rate was 12.46%. The amount of surgical setback, overbite (positive values), overjet, depth of the curve of Spee, and lower anterior facial height showed statistically significant differences between groups. The amount of surgical setback, overbite (positive values), overjet, and depth of the curve of Spee showed statistically significant correlations with the amount of relapse. Skeletal relapse of the mandible increased significantly as the overbite increased. Conclusion: The factors for instability in the surgery-first approach include a larger overbite, a deeper curve of Spee, a greater negative overjet, and a greater mandibular setback. The initial overbite may be an indicator to predict possible skeletal relapse of mandibular setback. (C) 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 71:e215-e223, 2013